CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Community Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $143
Cash Discount Price: $96
vs. Medicare Baseline: 4.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Community Memorial Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.24x the Medicare baseline. Located in W180 N8085 Town Hall Rd, Menomonee Falls, WI.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $96 (285%)

Insurance Median: $143 (424%)

Cash: $96 (285% of Medicare)

Ins. Median: $143 (424% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 424% of the Medicare baseline (a markup of 324%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Allwell	$32	95%
Blue Cross Blue Shield	$32 - $329	95%
Community Care	$32	95%
Health Partners	$32 - $116	95%
Humana	$32	95%
Icare	$32	95%
Network Health Plan	$32 - $263	95%
Security Health Plan	$32	95%
UnitedHealthcare	$32 - $370	95%
Aetna	$33 - $125	98%
Care Wisconsin/Mychoice	$33	98%
Centivo	$51 - $59	151%
Froedtert South	$71 - $75	210%
Chorus Community Health Plan	$73 - $77	216%
Common Ground	$101 - $107	299%
Trilogy	$117 - $124	347%
Health Payment Systems	$118 - $125	350%
Wisconsin Physician Services	$118 - $125	350%
Aspirus	$135 - $143	400%
Ibsi Passport	$137 - $145	406%
Americas Choice	$147 - $156	436%
Federated Mutual	$147 - $156	436%
Healtheos	$147 - $156	436%
Multiplan/Private Healthcare Systems	$147 - $156	436%
Savility	$147 - $156	436%
Cigna	$149 - $158	442%
First Health Network	$149 - $158	442%
Healthsmart	$152 - $161	451%
Physicians Plus	$152 - $161	451%
Sheboygan Employers Health Network	$294	872%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $96.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Community Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.